The impact of lockdown during the COVID-19 pandemic on mental and social health of children and adolescents

  1. Michiel A. J. Luijten
  2. Maud M. van Muilekom
  3. Lorynn Teela
  4. Tinca J. C. Polderman
  5. Caroline B. Terwee
  6. Josjan Zijlmans
  7. Leonie Klaufus
  8. Arne Popma
  9. Kim J. Oostrom
  10. Hedy A. van Oers
  11. Lotte Haverman

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Abstract

Purpose

During the COVID-19 pandemic in the Netherlands, governmental regulations resulted in a lockdown for adults as well as children/adolescents. Schools were closed and contact with other people was limited. In this cross-sectional, population-based study, we aimed to investigate the mental/social health of children/adolescents during COVID-19 lockdown.

Methods

Two representative samples of Dutch children/adolescents (8–18 years) before COVID-19 (2018, N  = 2401) and during lockdown (April 2020, N  = 844) were compared on the Patient-Reported Outcomes Measurement Information System (PROMIS) domains: global health, peer relationships, anxiety, depressive symptoms, anger, sleep-related impairment by linear mixed models and calculating relative risks (RR (95% CI)) for the proportion of severe scores. Variables associated with worse mental/social health during COVID-19 were explored through multivariable regression models. The impact of COVID-19 regulations on the daily life of children was qualitatively analyzed.

Results

Participants reported worse PROMIS T -scores on all domains during COVID-19 lockdown compared to before (absolute mean difference range 2.1–7.1 (95% CI 1.3–7.9). During lockdown, more children reported severe Anxiety (RR = 1.95 (1.55–2.46) and Sleep-Related Impairment (RR = 1.89 (1.29–2.78) and fewer children reported poor Global Health (RR = 0.36 (0.20–0.65)). Associated factors with worse mental/social health were single-parent family, ≥ three children in the family, negative change in work situation of parents due to COVID-19 regulations, and a relative/friend infected with COVID-19. A large majority (> 90%) reported a negative impact of the COVID-19 regulations on daily life.

Conclusion

This study showed that governmental regulations regarding lockdown pose a serious mental/social health threat on children/adolescents that should be brought to the forefront of political decision-making and mental healthcare policy, intervention, and prevention.

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  1. Version published to 10.1007/s11136-021-02861-x
  2. ScreenIT

    SciScore for 10.1101/2020.11.02.20224667: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Some limitations of this study need to be taken into account. Although the aim was to obtain two representative samples that were completely comparable, small differences were found on age, parental country of birth and educational level, and family composition. However, these differences were corrected for in our comparisons between the groups. In addition, the data collection during COVID-19 took place in April and May (2020), whereas the study data collection before COVID on anxiety and depression mainly took place in January and February (2018). Worse mental health is often reported during winter times.35 This difference could have led to an underestimation of the actual impact of the COVID-19 lockdown. We found that children and adolescents from families with certain risk factors (e.g. single parent families) are more vulnerable to mental and social health problems. These children and adolescents should be in sight of health care professionals. However, in this study children and adolescents with existing mental or somatic problems were not included, while it is conceivable that these groups are even more vulnerable. More research is needed to study the mental and social health of these groups as well as to gain insight in the longitudinal effects, and to clarify if lower mental and social health scores are mainly due to the COVID-19 pandemic or the lockdown. During the finalization of this paper, the Netherlands, and many other countries, are facing a second COVID-19 wa...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.11.02.20224667v1 on medRxiv